THE RELATIONSHIP OF HEADACHE FREQUENCY TO HORMONE USE IN MIGRAINE Lee Kudrow, M.D. THE association between intrinsic estrogen changes and Menstrual migraine was reported by Somerville.1 Others have reported a relationship of an increased incidence of vascular headache to the use of oral contraceptives.2,3,4,5 Many of these studies have been concerned with populations of birth control pill users. However, there is lacking definitive documentation of increased headache frequency associated with extrinisic estrogens in a migrainous population; although this relationship is generally observed by headache clinicians. Furthermore, there is little data regarding the relationship of oral contraceptives to initial headache onset (and subsequent periodic headaches) among women having negative family histories of migraine. It is the purpose of this study to: 1. Quantitatively document changes in headache frequency associated with the use of extrinsic estrogens among migrainous populations. 2. Quantitate and compare the family history data (for migraine) of women suffering periodic vascular headaches before and after starting birth control pills. 3. Document changes in headache frequency after withdrawal of extrinisic hormones. This study is carried out in two parts. The first is concerned with the association of family history and migraine headaches, particularly in users of oral contraceptives; and the relationship of headache frequency and hormones in patients with migraine. The second part of this study concerns itself with the changes in headache frequency following the restriction of hormone use. PART I METHOD OF STUDY Three hundred out-patients with migraine headache,6 were randomly selected and followed over a 3 month period at the California Medical Clinic For Headache. Approximately 10% of these patients were diagnosed as Classical Migraine and included without further distinction in the present study. "Combination Headache" with a migrainous component was excluded. Patients were separated into four groups. Group A represents "B.C. Migraine" designating those women using estrogen containing oral contraceptives. The type or concentration of estrogen was not distinguished as essential for this study. Group B represents "Estrogen Migraine" describing those women using supplemental or replacement estrogen preparations other than oral contraceptives. Again, the various preparations were not considered essential. Group C represents "Non-Hormonal Migraine" designating menstrual and non-menstrual women using no hormones. Group D represents "Migrainous Males" included only for comparison. All patients were provided with a conventional calendar and instructed to record all headache attacks. Office visits were 2 weeks apart for the first month and monthly for 2 succeeding months. All patients were allowed to abort an acute headache attack with either analgesics and/or vasocontrictors; however, prophylactic medication was withheld. DESCRIPTION OF DATA Of 300 patients, 239, or 80%, were women and 61 were men. Of the 239

TABLE 1 Age, Sex and Family History Data of Migraine Study Groups Group Designation

Migraine Group

. N

Ave Age

Family history of migraine No. %

A B C D

B.C.Migraine Estrogen Non-Hormonal Male

60 87 92 61

28 37 37 35

32 68 70 48

(53) (79) (76) (79)

Women Total

239 300

35 35

165 213

(69) (71)

TABLE 2 Relationships of Oral Contraceptive Use And Onset of Initial Migraine Attack to Family History Incidences of Migraine. (Group A)

Headache onset Before Starting B.C. pills After Starting B.C. pills Total

No.

(%)

Positive family Hx. of Migraine No. (%)

25

(42)

18

(72)

35 60

(58) (100)

14 32

(40) (53)

women, 62% were using estrogens in one form or another. The average age for each sex was 35, as seen in Table 1. A positive family history incidence of migraine headache was similar (76% to 79%) among estrogen using women, non-estrogen using women and males. The oral contraceptive group had a significantly lower incidence of a migrainous family history, (53%). p